Back to ePosters

OBJECTIVES Aortic prosthetic graft infection is a major challenge in vascular surgery carrying high morbidity and considerable mortality. Eradicating infection requires total prosthetic material removal, debridement and lower limb revascularization. Purpose of this single-institution retrospective study is to present our results on in situ replacement of infected aortic graft with lower extremity deep veins.
METHODS: From October 2000 until March 2013, 53 patients were operated on aortic prosthesis infection with total graft removal and reconstruction of neo-aortoiliac (NAIS) system of superficial femoro-popliteal veins.
Median time from primary aortic reconstruction to infection diagnose was 36 month (10 days - 288 month), most common presenting symptom were fever and groin infection. 5 (9%) patients were treated as emergencies. For NAIS system one or both superficial femoral veins were harvested, proximally split and sewn together to match aortic diameter. Proximal anastomosis was enforced with piece of tensior fasciae lata and distal anastomoses were covered with sartorius muscle in the groin. 13 patients (25%) required intestinal resection or suturation because of aorto-enteric erosion or fistula. Most common bacterias isolated were Staphylococcus epidermidis and aureus, Enterobacter cloacae and E.coli, in 17 (32%) cases bacterial growth remained negative. Post-operatively intravenous antimicrobial therapy was administered at least 6 weeks.
RESULTS: There were 7 (13%) in-hospital death and three patients (6%) required major amputation. Re-infection rate was 2 (4%) and 4 patients continued life-long antibiotic therapy because of remained prosthetic material. Edema from venous harvesting appeared in 6 patients (11%).
CONCLUSIONS: In situ reconstruction with NIAS presents acceptable rates of mortality and morbidity remaining preferred operative treatment method for aortic prosthesis infection in Helsinki University Hospital.